Back pain is complex. The same interventions which work for some can be detrimental to others. An Internet search throws up thousands of suggestions of what to do and what not to do. Some advice is bewildering, some conflicting, some useful, and some just what you need. But how do you find that needle in the haystack? The answer is through a personalised, focused and fact driven approach called Safe Intelligent Experimentation.
In this article I (Armand Brevig) will share with you a simple 4-step model. A common-sense way of thinking about your back pain recovery. These are realisations I have made over time during my own recovery journey. I had a herniated disc, sciatica and debilitating lower back pain (lumbago). Now I am completely pain free and my health has improved dramatically. My 6-year journey would have taken only 18 months if I had had all the insights up front which I am now about to share with you. See the animated video on the side bar of what happened to me. I hope what I am about to share with you will save you years of pain!
But why experiment at all? Why not just find “the solution” and be done with it? As Richard Moore, Osteopath and founder of Moore Osteopathy, Nottingham, UK puts it, “People often don’t understand how individual back pain is. They may say something like ‘Paul at work had back pain. I tried the stretches that help him, but I’m not better’. My response is, ‘You are not Paul!’ Different causes and issues altogether. People think back pain is back pain, but it’s not. What I love about my job is that every patient is different. You need to investigate, be a bit of a detective to find the combination of interventions that are just right for that person.”
Also, there is a very slim chance that the public health system will be able to help you out with your back pain. To find out why, read My Doctor will sort out my back pain – right? and Is your doctor NOT helping you recover from back pain? Here’s how to get correctly diagnosed and treated (Part 1)
The article, Free yourself from back pain by “taking ownership” explains why YOU must lead the process of discovering your own back pain solutions. So, accepting that you need to be in the driver’s seat of your own experimentation, here is what the Safe Intelligent Experimentation model looks like (told you it was simple!)
STEP 1 – Understand
Trying to solve a problem you don’t understand is tough. Before trying to figure out what to do next, gain as much insight about your back pain as possible. What’s causing it? What may be some contributing factors?
Certain diagnostic tests and scans may be helpful. For example, an MRI scan (Magnetic Resonance Imaging) could reveal disc herniation or Modic changes, which could be contributing to your pain. See the article, Startling facts about antibiotics and back pain. It is important to realise that single tests and scans may not tell the full story. Nor may they give any conclusive answers. Yet, collectively they will help piece together the picture. So will an examination by a good physical therapist.
Matt Taylor, Clinical Director of Response Physiotherapy, Nottingham, UK says that, “Together with other diagnostics, MRIs provide for a more informed decision of how to treat back pain. The key to making sense of inconclusive MRIs is to look at the body as a total system, rather than a discrete collection of parts”. See the articles, Is your doctor NOT helping you recover from back pain? Here’s how to get correctly diagnosed and treated (Part 1)
There may be types of diagnostics available to you which you have not considered, or even heard about! Recovered back pain sufferer, Steve Brunskill, explains that, “the first thing I did to diagnose my back problem was go private to have a “standing MRI” done. I had heard that it can show details more accurately than conventional MRIs”. Read, Getting out of back pain hell. How Steve took responsibility and developed an empowering mind-set.
Physios, chiropractors, and other therapists can help detect many back pain related issues. These issues may include muscle imbalances, posture problems and leg length discrepancy. See the article, Is leg length discrepancy sabotaging your back pain recovery? It is important to understand and address these issues to recover successfully. As Matt points out, “If you attempt to strengthen up a body that is trying to compensate for an issue, you will fail for sure”.
Getting second, third and even fourth opinions from different types of therapists may help you zoom in on key problems. You may also gain a broader view of causes of your back pain. No single expert has all the answers. For example, I needed to see 4 different therapists before critical issues with my posture were identified and addressed. Recovered back pain sufferer, Jason Motley, says that, “In hindsight I wish I had sought second opinions much sooner”. Read his story, How Jason became pain free in 3 weeks, after 18 years of back pain.
By examining your own lifestyle, certain factors contributing to your pain may become obvious. Obesity, prolonged sitting, physical fitness level and past injuries are a few of them. If you belong to the large group of people working “desk jobs”, consider how that may have contributed to your back pain. Richard says, “I think the sedentary lifestyle is a factor in most, if not all, cases of lower back pain in people who sit down for a living.” See the article, Here are some quick ways office workers can avoid back pain.
You will likely already have tried some interventions to get rid of your back pain. The outcomes of those efforts also represent valuable insight.
STEP 2 – Hypothesis
Insights from diagnostics, therapists and knowledge of your own situation, give you a good foundation to build on. You can now create a hypothesis about your back problems based on facts. This hypothesis summarises what you believe to be true about your back pain at this point in time. It will evolve as new experiments give you fresh insights.
Having a hypothesis, you can now begin to research and map the interventions that are likely to work, given your unique set of circumstances. What has worked for others in circumstances similar to yours? You can get ideas from BackMentorMe, your therapist(s) and published literature. Matt says, “Most clients will have researched their back pain on the Internet before seeing a therapist. The fact that people will now go out and find information for themselves is empowering.”
You then need to map all these ideas according to how compelling they are and how easy they are to implement. This 2×2 matrix can help you get the job done:
By “compelling” I mean how likely something is to work for you, while also taking the risks involved into consideration. “Ease of implementation” is also personal to you. For example, if an intervention means spending a lot of money, you may find it difficult, depending on your financial situation. Your work situation may also put certain constraints on you. Richard points out that “the nature of the job makes it challenging for some to make changes to their routines. For example, some of my clients with back problems due to a sedentary lifestyle, still need to drive long distances as part of their jobs”.
STEP 3 – Experiment
You are now almost ready to start testing out the solution in the upper right most part of the “Start here” box. But before you do so, consult with a therapist you trust to make sure what you are about to do is both safe and desirable. If you don’t already know suitable therapists, read 7 Tips on choosing the right therapists to help you recover from back pain faster.
Therapists, like people in general, have different areas of knowledge, attitudes and beliefs. So, it is vital to pick one who is non-judgmental and willing to truly listen to you. Someone with a small ego who accepts that some solutions may lie outside his or her areas of expertise. The right therapist may be able to support you throughout your entire recovery journey. However, you may need more than one to support you.
Matt, recognises that patient expectations have changed over time, “Now that the public is more educated, people want to be involved in their own diagnosis and health care. This is possible if you have somebody experienced to discuss your case with. I am open to any intervention. It depends on the circumstances.”
Once you get started with your experimentation, it is vital to only try out one intervention at a time. Otherwise you will not know what truly worked. It is equally important to meticulously track progress. Improvements are likely to be incremental, so you may miss subtle signs of recovery if you don’t have a tracking system in place. Picking up on small trends also serves as valuable insight for your supporting therapist. This insight allows him or her to better help you recover faster and make adjustments when needed.
Carol Drummond, Physiotherapist at Response Physiotherapy, Nottingham, United Kingdom, asks her clients to track how they are feeling on a 24 hour basis. Morning, midday and evening/night. “The things for clients to look for are stiffness, swelling, pain, discomfort, reduced/increased mobility, etc. In terms of pain, I am interested in a description of the type of pain. Does it feel like someone is sticking a needle in you? Or is it more like a pounding pain? Generally, subjective information provided by the client is very important in terms of gaining as accurate an understanding of the client’s condition as possible.” See the article, Why people who track their progress almost always recover quicker from back pain.
At some stage, strengthening-up is likely to form part of the solution. But it needs to be done right in order not to cause more problems for you. See the article, How to build core strength when your injured body sabotages every effort!
STEP 4 – New Insight
This last step is about looking back at your experiment – the overall experience and the data you collected. Did your situation improve in some way? Are you taking fewer painkillers? See, How to avoid becoming a painkiller addict, while still controlling your back pain. Even if your situation didn’t improve, what did you learn? Did your experimentation reveal other related issues which you were not previously aware of? Back pain can often be compared to peeling an onion. There are layers. You address one issue (layer) and other issues are exposed underneath. If that’s your experience, go back to Step 1. However, realise you are now going back armed with the experience of an effective process and strategy!
Safe Intelligent Experimentation is truly a journey worth undertaking. I speak from personal experience. Best of luck! If you ever get stuck in any way, the BackMentorMe Transformative Mentoring service is there to support you by helping you tap deeper into your own internal wisdom.
- Gain as much insight into what is causing, your back pain as possible.
- Map the options available to you based on how compelling and easy to implement.
- Seek support from a local therapist or expert you trust. Then start testing back pain solutions one at a time.
If you have already made a lot of progress, or become pain free, why not inspire others by sharing your story?
If someone you know suffers from back pain, why not send them a link to this article by using the email share button below?